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Parsi K, De Maeseneer M, van Rij AM, Rogan C, Bonython W, Devereux JA, Lekich CK, Amos M, Bozkurt AK, Connor DE, Davies AH, Gianesini S, Gibson K, Gloviczki P, Grabs A, Grillo L, Hafner F, Huber D, Iafrati M, Jackson M, Jindal R, Lim A, Lurie F, Marks L, Raymond-Martimbeau P, Paraskevas P, Ramelet AA, Rial R, Roberts S, Simkin C, Thibault PK, Whiteley MS. Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants. Phlebology 2024:2683555241260926. [PMID: 39046331 DOI: 10.1177/02683555241260926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity. OBJECTIVES To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents. METHODS An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations. RESULTS Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended. CONCLUSION Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy.
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Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Department of Dermatology, St Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | | | - Andre M van Rij
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Christopher Rogan
- Interventional Radiology Society of Australasia (IRSA), Camperdown, NSW, Australia
- Department of Medical Imaging, Sydney Adventist Hospital, Sydney, NSW, Australia
- Macquarie University Hospital, Sydney, NSW, Australia
| | - Wendy Bonython
- Faculty of Law, Bond University, Gold Coast, QLD, Australia
| | - John A Devereux
- University of Queensland Law School, University of Queensland, Saint Lucia, QLD, Australia
| | | | - Michael Amos
- Department of Anaesthesiology, Concord Hospital, Sydney, NSW, Australia
| | - Ahmet Kursat Bozkurt
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Department of Cardiovascular Surgery, Istanbul University, Istanbul, Turkie
| | - David E Connor
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Alun H Davies
- European College of Phlebology, Rotterdam, The Netherlands
- Vascular Surgery, Imperial College London, Charing Cross and St Mary's Hospital, London, UK
| | - Sergio Gianesini
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular Surgery, University of Ferrara, Ferrara, Italy
| | | | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Anthony Grabs
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Vascular Surgery, St Vincent's Hospital, Sydney, NSW, Australia
| | - Lorena Grillo
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular Surgery, University of Medical Sciences (UCIMED), San Jose, Costa Rica
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David Huber
- Art of Vein Care, Wollongong, NSW, Australia
| | - Mark Iafrati
- American Venous Forum (AVF), East Dundee, IL, USA
- Vanderbilt University Medical Center, Vanderbuilt University, Nashville, TN, USA
| | - Mark Jackson
- Australian and New Zealand Society for Vascular Surgery(ANZSVS), Melbourne, VIC, Australia
- Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Ravul Jindal
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular Surgery, Fortis Hospital, Mohali, India
| | - Adrian Lim
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Fedor Lurie
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Jobst Vascular Institute, Toledo, OH, USA
- Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Marks
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Brighton Day Surgery, Adelaide, SA, Australia
| | - Pauline Raymond-Martimbeau
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Dallas Non-Invasive Vascular Laboratory and Vein Institute of Texas, Dallas, TX, USA
| | | | | | - Rodrigo Rial
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular and Endovascular Surgery, University Hospital HM Madrid, Torrelodones, Spain
| | | | - Carlos Simkin
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Clínica Simkin, Buenos Aires, Argentina
| | - Paul K Thibault
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Central Vein and Cosmetic Medical Centre, Newcastle, NSW, Australia
| | - Mark S Whiteley
- The College of Phlebology, Guildford, UK
- The Whiteley Clinic, Guildford, UK
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Öztan G, Bozbuğa N, İşsever H, Oğuz F, Canıaz İ, Yazıksız N, Ertan M, Alpagut İU. Comparative Analysis of Transcriptome Profiles in Patients with Thromboangiitis Obliterans. Genes (Basel) 2023; 15:19. [PMID: 38275601 PMCID: PMC10815726 DOI: 10.3390/genes15010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Thromboangiitis obliterans (TAO) causes vascular insufficiency due to chronic inflammation and abrupt thrombosis of the medium and small arteries of the extremities. In our study, we aimed to determine biomarkers for the diagnosis of TAO by evaluating 15 male TAO patients with Shinoya diagnostic criteria and 5 healthy controls who did not have TAO-related symptoms in their family histories. METHODS The Clariom D Affymetrix platform was used to conduct microarray analysis on total RNA extracted from whole blood. A total of 477 genes (FC ≤ 5 or >5) common to the fifteen patient and five control samples were selected using comparative microarray analysis; among them, 79 genes were upregulated and 398 genes were downregulated. RESULTS According to FC ≤ 10 or >10, in the same TAO patient and control group, 13 genes out of 28 were upregulated, whereas 15 genes were downregulated. The 11 key genes identified according to their mean log2FC values were PLP2, RPL27A, CCL4, FMNL1, EGR1, EIF4A1, RPL9, LAMP2, RNF149, EIF4G2, and DGKZ. The genes were ranked according to their relative expression as follows: FMNL1 > RNF149 > RPL27A > EIF4G2 > EIF4A1 > LAMP2 > EGR1 > PLP2 > DGKZ > RPL9 > CCL4. Using protein-protein interaction network analysis, RPL9, RPL27A, and RPL32 were found to be closely related to EIF4G2 and EIF4A1. The Reactome pathway found pathways linked to 28 genes. These pathways included the immune system, cellular responses to stress, cytokine signaling in the immune system, and signaling by ROBO receptors. CONCLUSIONS By figuring out the protein expression levels of the genes that have been found to explain how TAO disease works at the molecular level, it will be possible to figure out how well these chosen transcripts can diagnose and predict the disease.
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Affiliation(s)
- Gözde Öztan
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey;
| | - Nilgün Bozbuğa
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - Halim İşsever
- Department of Public Health, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey;
| | - Fatma Oğuz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey;
| | - İrem Canıaz
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - Nilgün Yazıksız
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - Melike Ertan
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
| | - İbrahim Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul Faculty of Medicine, Istanbul University, Topkapi, 34093 Istanbul, Turkey; (N.B.); (İ.C.); (N.Y.); (M.E.); (İ.U.A.)
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Fazeli B, Poredos P, Patel M, Klein-Weigel P, Catalano M, Stephen E, Al Salman MM, Altarazi L, Bashar AH, Chua B, Colgan MP, Cvjetko I, Desai S, Dimakakos EP, Erer D, Farkas K, Fowkes GR, Gerotziafas G, Hussein E, Ionac M, Iwai T, Karahan O, Kolossvary E, Kota A, Kozak M, Kroger K, Kumar PP, Liew A, Malecki R, Najafi MH, Olinic DM, Pandey SR, Pecsvarady Z, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sermsathanasawadi N, Sharebiani H, Stanek A, Szuba A, Taheri H, Wautrecht JC, Hakan Zor M. Milestones in thromboangiitis obliterans. A position paper of the VAS-European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2021; 40:395-408. [PMID: 34236154 DOI: 10.23736/s0392-9590.21.04712-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unfortunately, even today Thromboangiitis Obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. METHODS A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. RESULTS Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. CONCLUSIONS AND RELEVANCE An international group of experts however came to one conclusion. They all agree that management of TAO is in need of a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.
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Affiliation(s)
- Bahare Fazeli
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pavel Poredos
- Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia -
| | - Malay Patel
- Vascular Surgery Department, Apollo CVHF Hospital, Ahmedabad, India
| | - Peter Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Mariella Catalano
- Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
| | - Edwin Stephen
- Vascular Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mussaad M Al Salman
- Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abul H Bashar
- National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh
| | - Benjamin Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ivan Cvjetko
- James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Sanjay Desai
- Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia
| | - Evangelos P Dimakakos
- Department of vascular and endovascular surgery, Ramaiah Medical College Hospital, Bangalore, India
| | - Dilek Erer
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katalin Farkas
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | | | | | - Emad Hussein
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Mihai Ionac
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Takehisa Iwai
- Vascular surgery department, Ain Shams University, Cairo, Egypt
| | - Oguz Karahan
- Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, Romania
| | - Endre Kolossvary
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | - Albert Kota
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Matija Kozak
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
| | - Knut Kroger
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prabhu P Kumar
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Aaron Liew
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Rafal Malecki
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Mohammad H Najafi
- Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Dan M Olinic
- Department of Angiology, Systemic hypertension and diabetology
| | | | | | - Hasan Ravari
- Department of Cardiology, Tehran Medical Unit, Azad University, Tehran, Iran
| | - Vimalin Samuel
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Gerit Schernthaner
- Medical Clinic No 1, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dheepak Selvaraj
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | | | - Hiva Sharebiani
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Agata Stanek
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Andrzej Szuba
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Hossein Taheri
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean Claude Wautrecht
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Mustafa Hakan Zor
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Place of Polygeline in Fluid Resuscitation: Focus on Hypovolemic Shock. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Piety NZ, Reinhart WH, Stutz J, Shevkoplyas SS. Optimal hematocrit in an artificial microvascular network. Transfusion 2017; 57:2257-2266. [PMID: 28681482 DOI: 10.1111/trf.14213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Higher hematocrit increases the oxygen-carrying capacity of blood but also increases blood viscosity, thus decreasing blood flow through the microvasculature and reducing the oxygen delivery to tissues. Therefore, an optimal value of hematocrit that maximizes tissue oxygenation must exist. STUDY DESIGN AND METHODS We used viscometry and an artificial microvascular network device to determine the optimal hematocrit in vitro. Suspensions of fresh red blood cells (RBCs) in plasma, normal saline, or a protein-containing buffer and suspensions of stored red blood cells (at Week 6 of standard hypothermic storage) in plasma with hematocrits ranging from 10 to 80% were evaluated. RESULTS For viscometry, optimal hematocrits were 10, 25.2, 31.9, 37.1, and 37.5% for fresh RBCs in plasma at shear rates of 3.2 or less, 11.0, 27.7, 69.5, and 128.5 inverse seconds. For the artificial microvascular network, optimal hematocrits were 51.1, 55.6, 59.2, 60.9, 62.3, and 64.6% for fresh RBCs in plasma and 46.4, 48.1, 54.8, 61.4, 65.7, and 66.5% for stored RBCs in plasma at pressures of 2.5, 5, 10, 20, 40, and 60 cm H2 O. CONCLUSION Although exact optimal hematocrit values may depend on specific microvascular architecture, our results suggest that the optimal hematocrit for oxygen delivery in the microvasculature depends on perfusion pressure. Therefore, anemia in chronic disorders may represent a beneficial physiological response to reduced perfusion pressure resulting from decreased heart function and/or vascular stenosis. Our results may help explain why a therapeutically increasing hematocrit in such conditions with RBC transfusion frequently leads to worse clinical outcomes.
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Affiliation(s)
- Nathaniel Z Piety
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, Texas
| | | | - Julianne Stutz
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, Texas
| | - Sergey S Shevkoplyas
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, Texas
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